Limb Salvage Rate after ligation of Infected Femoral Pseudo Aneurysms in Intravenous Drug Abusers, Clinical Experience with 17 Cases

Background: Infected femoral artery pseudoaneurysm (IFAP) is a severe complication in parenteral drug abusers, with difficult and controversial management. Methods: Seventeen consecutive patients were admitted to our department with IFAP due to intravenous drug abuse. In all 17 patients proximal and distal ligation of common femoral artery was performed with drainage of the abscess and excision of the pseudoaneurysm without reconstruction. The lower limb was monitored for symptoms of acute ischemia including coldness, sensory and motor impairment, as well as changes in color and capillary refilling. Results: In all 17 patients, the affected artery was ligated.Ligation of the common femoral or superficial femoral artery alone was performed in 13 and 4 of the cases, respectively. In eight cases the pseudoenurysm involved the distal, in six the mid, and in three the inferior border of the inguinal ligament. We did not have bifurcation involvement and need for triple ligation (common, superficial and profunda femoral artery). Patients were closely observed during and following surgery, and this led to revascularization in two patients who demonstrated symptoms of acute ischemia.In one of them bypass surgery was performed 24 hours after surgery and led to amputation due to failed revascularization, and the other patient was required revascularization 2 months after ligation of common femoral artery because of severe intermittent claudication of affected limb. Conclusions: In the setting of complex infected femoral pseudoaneurysms in patients prone to substance abuse, our work demonstrates that ligation and excision of IFAP without reconstruction may be the preferred option.